Clinical Analysis Of 108 Patients With Myasthenia Gravis And Literature Review

Objective:Myasthenia gravis(MG)is a kind of acetylcholine receptor antibody(anti-acetylcholine receptor antibody,AChR-Ab)mediated,cellular immune dependence,complement participation,involvement of the neuromuscular junction synaptic membrane,causing neuromuscular junction obstruction,and acquired autoimmune disease with skeletal muscle weakness.The clinical manifestations were mainly skeletal muscle weakness and fatigue.In recent years,it has been found that other parts of the skeletal muscle,such as eye muscle and smooth muscle,have also been damaged,and the clinical manifestations are complex and diverse,and the detection of antibodies and electrophysiology has not been popularized.The doctors in primary hospitals have received doctors for the disease and misdiagnosis and mistreatment.At the same time,the standardized treatment of MG and the occurrence of myasthenia crisis are worthy of attention.The clinical features of MG were reviewed in order to summarize the clinical characteristics and the literature review,expecting to improve the further understanding of the disease.Method:108 patients with MG were treated in the Department of Neurology of Xi'an Gaoxin hospital from November 2003 to April 2017.The clinical data of patients were analyzed retrospectively,including age,sex,first symptom,course of disease,misdiagnosis of first diagnosis,first cause of disease,disease progression,complication,clinical classification,bed score,imaging,the results of neostigmine test,antibody,neuroelectrophysiological results,medication regimen,surgical treatment,crisis classification,crisis inducement,crisis duration,crisis treatment,muscle atrophy and so on.Microsoft Excel 2003 was used to establish database and input clinical data collected.Data were processed and analyzed by SPSS 18 statistical software.P<0.05 was statistically significant.Result:A total of 234 hospitalized data of 108 patients with MG from November 2003 to April 2017 were collected,of which 43 cases were admitted to hospital many times;52 men(48.15%),56 women(51.85%),and male: female =1:1.08.The age of onset was 1 years andthe age of 79 was the first time.15 years of age(20 cases),11 male and 9 female,male:female =1:0.81,16~30 year old(21 cases),13 men,8 women,male: =1:0.62,31~45 year old(20 cases),9 men,11 male,=l:1.22,46~60 years(24 cases),male cases,female cases,male:female=1:1.There were 7 males and 16 females,male: female=1:2.28.The duration of the first visit to our hospital was 38 years and the shortest was 2 days.There were 17 cases(15.74%)of obvious inducements at first onset,and 23 cases(21.29%)had obvious inducements in our hospital for the first time.7 first symptoms were found at the onset of the disease,60 cases of ptosis,12 cases of diplopia,9 cases of ptosis with diplopia,18 cases of weak limb strength,6 chewing difficulties,2 cases of difficulty in the rise of the head,and 1cases of verbal vagueness.The first amelioration of Osserrnan type: type I 25 cases(23.15%),type II A type 28 cases(25.92%),type II B type 35 cases(32.41%),type III 11 cases(10.18%),type IV 9 cases(8.3%).Of the 108 patients,40 patients detected the AChR-Ab titer,the positive rate was 75%,the titer of AChR antibody was correlated with the age of onset(r=0.361,P=0.022),there was no correlation with the course of disease(r=0.132,P=0.418),there was no correlation with the clinical absolute score(r=0.043,P=0.792),there was a correlation with the improved Osserman typing(r=0.339,P=0.032).98 cases had thymus CT and enhanced scan,thymus abnormal 59 cases(60.2%),83 cases were first diagnosed as MG,25 cases were misdiagnosed(23.15%),19 cases(17.59%)had crisis in the first admission,followed by many times of admission,there were 30 times,4 cases appeared muscle atrophy.Conclusion:1.clinical characteristics: MG female patients are more common,the first symptoms of unilateral eyelid drooping more common,young MG to I type,adult MG with type II B,low frequency repetitive nerve stimulation has a high abnormal rate of accessory nerve,easy to merge thyroid dysfunction.2.AChR-Ab titer has a correlation with the onset age and the improved Osserman typing.There is no correlation between the AChR-Ab titer and the clinical absolute score,suggesting that the severity of the disease can not be predicted by the AChR-Ab titer in different MG patients.3.MG patients appear cough weakness,respiratory tract secretion increased,myasthenia,irritability and chest tightness and shortness of breath and other symptoms,alert myasthenia crisis occurs.4.Short term high-dose hormone therapy combined with other immunosuppressive agents is beneficial to the short-term relief of MG,and can improve the MG precrisis state and symptoms of myasthenia crisis.5.MG with muscular atrophy is rare,tongue muscle atrophy often occurs in patients with MuSK-Ab positive,but AChR-Ab positive patients can also have tongue muscle atrophy,and MuSK-Ab positive patients with rituximab are stable after treatment,suggesting that rituximab has potential value for refractory MG.